245 Screening depression and anxiety in patients with cystic fibrosis and parent caregivers: preliminary results from a pilot program at pediatric and adult CF centers

Depression and anxiety prevalence in people with cystic fibrosis and their caregivers: a systematic review and meta-analysis

BACKGROUND

Prevalence of depression and anxiety in people with cystic fibrosis (PwCF) and their caregivers is high, however, results have been inconsistent. This systematic review and meta-analysis aimed to estimate the prevalence of depression and anxiety in PwCF and their caregivers and explore sources of heterogeneity.

METHOD

MEDLINE, EMBASE, CINAHL plus and PsychINFO databases were searched from inception to January 2021. Studies were included if a specific psychometric tool (PT) to assess depression or anxiety (rather than quality of life) was used and did not involve a transitory patient state. Random-effects models were applied due to high anticipated heterogeneity and I2 estimates were calculated. Sources of heterogeneity were explored through subgroup comparisons. The presence of small-study effects was investigated visually using funnel plots and statistically using the Egger test.

RESULTS

A total of 94 articles (48 full-text publications, 46 abstracts) were included. Depression prevalence in adolescents aged 12-18 years (n = 2386), adults (n = 9206) and caregivers (n = 6617) were 18.7% (95% CI 12.8-25.3%, I2 = 89.2%), 27.2% (95% CI 23.6-31%, I2 = 90.4%), and 32.8% (95% CI 27.9-37.9%, I2 = 90.3%), respectively. Anxiety prevalence in adolescents aged 12-18 years (n = 2142) was 26% (95% CI 19.6-33%, I2 = 86.4%), 28.4% (95% CI 25-31.9%, I2 = 85%) for adults (n = 8175), and 38.4% (95% CI 30.8-46.2%, I2 = 94.6%) for caregivers (n = 5931). Prevalence differed by the PT used and study location.

DISCUSSION

This comprehensive analysis found the prevalence of depression and anxiety in PwCF and their caregivers to be high, supporting recommendations for regular screening. Choice of PT significantly influenced prevalence, indicating a need for future studies to identify the optimal PT for each CF population to identify those most at risk.

Caregiver burden in cystic fibrosis: a systematic literature review

BACKGROUND

Cystic fibrosis (CF) affects more than 80,000 people worldwide, having a considerable impact on the quality of life of patients and their caregivers, who assist patients with time-consuming treatment regimens. Despite this, a review of the available evidence has not been previously undertaken. This systematic literature review aimed to identify the humanistic and economic burdens of CF on caregivers.

METHODS

A systematic literature review was conducted, in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Publications reporting outcomes for the caregivers of people with CF, including utility data, health status, and occupational impact, were reviewed. Sources searched were Embase (OvidSP), Medline (PubMed), the Cochrane Database of Systematic Reviews, and the Epistemonikos database, from 2010 to March 2020. A subsequent search with updated terms identified articles up to April 2020. Electronic searches were supplemented by hand searches to capture all relevant literature.

RESULTS

A total of 889 articles reporting humanistic burden and 310 reporting economic burden were identified. Following full-text screening by two independent reviewers, 72 articles were included in the review, of which 65 and 17 reported data on humanistic and economic burdens, respectively, with 10 reporting on both. The reviewed literature covered several outcomes and identified multiple key findings: greater disease severity is associated with the reporting of greater caregiver burden and lower utility scores of quality of life; reduced patient lung function is associated with increased caregiver depression and anxiety; and caregiving causes significant occupational impact, with pulmonary exacerbations decreasing caregiver productivity by up to a third compared with the patient being in a 'well' state.

CONCLUSION

Findings from this systematic literature review highlight the substantial humanistic and economic burdens borne by the caregivers of people with CF. Future research would help to further inform on the link between disease severity and caregiver burden.